Article Text

Download PDFPDF

  1. Wilber Sabiiti1,
  2. Nyanda Ntinginya2,
  3. Davis Kuchaka3,
  4. Khalide Azam4,
  5. Elizabeth Kampira5,
  6. Bariki Mtafya2,
  7. Ruth Bowness1,
  8. Nilesh Bhatt4,
  9. Gerry Davies5,
  10. Gibson Kibiki6,
  11. Stephen Gillespie1
  1. 1University of St. Andrews, United Kingdom
  2. 2NIMR- MMRC, Tanzania
  3. 3KCRI, Tanzania
  4. 4INS, Mozambique
  5. 5University of Malawi, Malawi
  6. 6EAHRC, Burundi


Background Tuberculosis is a difficult disease to treat. We report a multi-centre performance evaluation of the molecular bacterial load assay (MBLA) that monitors change in patient bacterial load (BL) as they respond to TB therapy.

Methods Smear or Xpert MTB/RIF-positive patients were prospectively monitored for treatment response using MBLA and culture at four sites in Southeast Africa. Treatment response was defined as decline in BL and or rise in time to culture positivity (TTP) or conversion to negative culture status. Positive culture at 5 or 6 months confirmed treatment failure. MBLA-MGIT correlation and association with treatment outcome were determined by Spearman's ρ and logistic regression, respectively.

Results A total of 1764 serial samples from 178 patients were assessed for treatment response of which 91% were treatment success. Of those who failed treatment (n=17), MBLA detected TB in 82% at 2 months of treatment compared to MGIT 24% and LJ 6%. Mean BL at baseline was 6±1.3log10 CFU/ml falling to zero in 59% of the patients by 3 months of treatment. A corresponding rise in MGIT TTP, 5±3 to 22±11 was observed, r=–0.5, p<0.0001. The rate of sputum clearance (SLOPE) was high among high-burden patients – 1.0log10C-FU/ml than low-burden patients, –0.7log10CFU/ml in the first 2 weeks of treatment. Despite higher rates of clearance, high-burden patients were more likely to be TB-positive at 2 months of treatment, p=0.01(OR 2.5). Response was generally slower among the MDR than susceptible TB patients. Time to result was 4h with MBLA and 5–22 days for MGIT. Contamination was 25% in MGIT and 4% on solid culture.

Inter-site testing revealed that MBLA was reproducible, ANOVA p >0.05.

Conclusions MBLA is a contamination-insensitive, reproducible method capable of giving results in real-time. Direct quantification of bacterial load from uncultured sputum demonstrates considerable potential for application in resource-limited settings where TB culture facilities are scarce.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.